Ulcerative colitis

Ulcerative colitis is often called the big sister of Crohn’s disease. It is also believed to be of autoimmune origin. But inflammation is typically limited to the large bowel (colon and rectum) and extra intestinal manifestations (skin, joints etc.) are frequent. Severe inflammatory attacks can ultimately lead to a toxic mega colon when the bowel basically dissolves.


Another problem is malignant change, which occurs more frequently in ulcerative colitis and is very difficult to detect in an early stage. Risk factors for the development of cancer are:

  • Early onset of the disease (before the age of 16)
  • The disease involves the whole large bowel (pancolitis)
  • Difficult control of inflammation Ulcerative colitis for more than 10 years


Unlike in Crohn’s disease ulcerative colitis can be cured by an operation. This however is a very drastic procedure: The entire large bowel (colon and rectum) must be removed. This is called total proctocolectomy. In order to prevent a permanent stoma for the rest of the patient’s life a reservoir or pouch has to be constructed from the last loops of the small bowel in order to delay the passage of stool and enable resorption of fluids from the stool. This pouch is connected to the anal sphincter and after a period of recovery the patient will regain control of his bowel function and lead a normal life again. 2-3 bowel movements per day are considered a good result.


see figure 1  see figure 2